Provider Demographics
NPI:1407622400
Name:OTUNUBI ISHOLA, MOJISOLA AJARAT
Entity Type:Individual
Prefix:
First Name:MOJISOLA
Middle Name:AJARAT
Last Name:OTUNUBI ISHOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5327 85TH AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3223
Mailing Address - Country:US
Mailing Address - Phone:240-906-1280
Mailing Address - Fax:
Practice Address - Street 1:5327 85TH AVE APT 202
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3223
Practice Address - Country:US
Practice Address - Phone:240-906-1280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200003263374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty